Service of Geriatric Medicine and Geriatric Rehabilitation, Department of Medicine, University of Lausanne Medical Center (CHUV), Lausanne, Switzerland. christophe.bula @ chuv.ch
Gerontology. 2011;57(3):276-86. doi: 10.1159/000322241. Epub 2010 Oct 29.
Loss of balance confidence is a frequent condition that affects 20-75% of community-dwelling older persons. Although a recent fall is a common trigger, loss of balance confidence also appears independent of previous experience with falls. Maintaining or improving balance confidence is important to avoid unnecessary, self-imposed restrictions of activity and subsequent disability. Holding another person's hand or using an assistive device while walking are simple interventions that are used naturally to address poor balance confidence in daily life. However, more complex interventions have also been developed and tested to achieve more sustained improvement in balance confidence.
This review describes interventions that have been tested to improve balance confidence in older community-dwelling persons.
Based on 2 recent systematic reviews, an additional search for literature was performed to update current information on interventions aiming at balance confidence improvement. Interventions were classified as those directly aimed at increasing balance confidence or not, and further stratified into those using monofactorial or multifactorial approaches.
A total of 46 randomized controlled trials were identified. Five of the 8 interventions that directly targeted balance confidence showed benefits. Among those, multicomponent behavioral group interventions provided the most robust evidence of benefits in improving balance confidence and in decreasing activity avoidance. Among interventions not directly aiming at balance confidence improvement (11/21 studies with benefits), exercise (including tai chi) appears as the most promising monofactorial intervention. Nine of the 17 multifactorial fall prevention programs showed an effect on balance confidence, exercise being a main component in 7 of these 9 studies. Interventions that targeted elderly persons reporting poor balance confidence and/or those at risk for falls seemed more likely to be beneficial.
Positive and sometimes sustained improvement in balance confidence can be achieved by various interventions among community-dwelling elderly persons. The effect of these interventions on activity restriction associated with poor balance confidence have been less well studied, but some studies also suggest potential benefits.
平衡信心丧失是一种常见病症，影响 20-75%的社区居住老年人。尽管最近一次跌倒常常是触发因素，但平衡信心丧失似乎也与之前的跌倒经历无关。保持或改善平衡信心对于避免不必要的、自我施加的活动限制和随后的残疾很重要。在日常生活中，手握他人或使用助行器行走是简单的干预措施，用于解决平衡信心差的问题。然而，也已经开发和测试了更复杂的干预措施，以实现更持久的平衡信心改善。
本综述描述了已被测试用于改善社区居住老年人平衡信心的干预措施。
基于最近的 2 项系统综述，进一步搜索文献以更新关于旨在改善平衡信心的干预措施的当前信息。干预措施分为直接针对增加平衡信心的干预措施和不直接针对增加平衡信心的干预措施，并进一步分为使用单因素或多因素方法的干预措施。
共确定了 46 项随机对照试验。直接针对平衡信心的 8 项干预措施中有 5 项显示出益处。其中，多组分行为组干预措施提供了改善平衡信心和减少活动回避最有力的证据。在不直接针对平衡信心改善的干预措施（有 11/21 项研究显示有益）中，运动（包括太极拳）似乎是最有前途的单因素干预措施。9 项多因素防跌倒计划显示对平衡信心有影响，其中 7 项研究中运动是主要组成部分。针对报告平衡信心差和/或有跌倒风险的老年人的干预措施似乎更有可能有益。
各种干预措施可以在社区居住的老年人中实现平衡信心的积极且有时可持续的改善。这些干预措施对与平衡信心差相关的活动限制的影响尚未得到充分研究，但一些研究也表明有潜在益处。
